Basic (01-12)
DI 27536.005 Required Information for Reopening Initial Determinations
There is no need to duplicate information documented elsewhere in the file. Use the
tables below to locate the information required to reopen initial determinations;
and, what actions are necessary if the information is not already contained in the
file.
Required information for reopening an initial determination includes:
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-
•
Assessment of functional abilities
-
-
•
Citation of jobs and incidence
-
-
•
Evidence of substantial gainful activity (SGA) findings
-
-
•
Interpretation of medical findings
-
-
-
•
Resolution of conflicting medical opinions
-
•
Resolution of inconsistencies material to the determination
-
•
Vocational rule used for medical-vocational determinations
See Also:
DI 27536.001 Reopening Rationale Preparation
A. Location of required information
Use the table below to locate required information.
| Information |
Determination |
Where Usually Documented In File |
|
Allegations
|
Allowance
|
-
•
Personalized determination notice (PDN)
-
•
SSA-3368-BK Disability Report Adult
-
•
SSA-5002 Report of Contact
-
•
SSA-795 Statement of Claimant or Other Person
|
| |
Denial
|
|
|
Assessment of functional abilities
|
Allowance
|
-
-
•
SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment (MRFC)
-
•
SSA-4734-BK Physical Residual Functional Capacity Assessment (RFC)
|
| |
Denial
|
-
-
•
SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment (MRFC)
-
•
SSA-4734-BK Physical Residual Functional Capacity Assessment (RFC)
|
|
Basis for Determination
|
Allowance
|
SSA-831 Item 22 (Regulation basis code)
|
| |
Denial
|
|
|
Citation of jobs and incidence
|
Allowance
|
Not applicable
|
| |
Denial
|
Report by a Vocational specialist
|
|
Duration of impairment
|
Allowance
|
Favorable determination indicates duration met
|
| |
Denial
|
|
|
Evidence of substantial gainful activity (SGA) findings
|
Allowance
|
-
•
SSA-820-F4 Work Activity Report (Self-Employed Person)
-
•
SSA-821-BK Work Activity Report
-
|
| |
Denial
|
-
•
SSA-553 Special Determination
-
-
-
|
|
Evidence Sources
|
Allowance
|
|
| |
Denial
|
|
|
Interpretation of medical findings
|
Allowance
|
-
-
-
-
-
•
SSA- 2506-BK Psychiatric Review Technique (PRTF)
|
| |
Denial
|
|
|
Medical Facts
|
Allowance
|
|
| |
Denial
|
|
|
Pain Related Issues
|
Allowance
|
-
•
Any medical listing which specifically mentions pain
-
-
-
|
| |
Denial
|
|
|
Resolution of conflicting medical opinions
|
Allowance
|
Resolved by the determination of an allowance (SSA-831)
|
| |
Denial
|
|
|
Resolution of inconsistencies material to the determination
|
Allowance
|
-
-
•
Resolved by the determination of an allowance (SSA-831)
|
| |
Denial
|
|
|
Vocational rule used for medical-vocational determination
|
Allowance
|
Item 27 on the SSA-831
|
| |
Denial
|
Item 27 on the SSA-831
|
B. Rationale documentation required
A rationale must address specific information not already documented in the case file.
Use the table below to determine how you need to document the missing information.
| Information |
Where Usually Documented In File |
Required Action |
|
Citation of jobs and incidence
(denial determination)
|
Report by a Vocational specialist
|
See DI 27536.001B.6.
|
|
Interpretation of medical findings
(allowance determination)
|
SSA-831 Item 22 (Regulation basis code)
|
See DI 27536.001B.5. (closed period only)
|
|
Interpretation of medical findings
(denial determination)
|
SSA-831 Item 22 (Regulation basis code)
|
See specific instructions for:
-
-
•
Resolution of conflicting medical opinions
-
•
Resolution of inconsistencies material to the decision
|
|
Pain-related issues
(denial determination)
|
SSA-4734-BK Physical Residual Functional Capacity Assessment
|
See DI 27536.001B.2.
|
|
Resolution of conflicting medical opinions
(denial determination)
|
-
•
SSA- 2506-BK Psychiatric Review Technique
-
•
SSA-4734-BK Physical Residual Functional Capacity Assessment
-
•
SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment
|
See DI 27536.001B.1.
|
|
Resolution of inconsistencies material to the determination
(denial determination)
|
-
•
SSA- 2506-BK Psychiatric Review Technique
-
•
SSA-4734-BK Physical Residual Functional Capacity Assessment
-
•
SSA- 4734-F4- SUP Mental Residual Functional Capacity Assessment
|
See DI 27536.001B.3.
|
|
Vocational rule used for medical-vocational determinations
(allowance or denial determination)
|
Item 27 on the SSA-831
|
See DI 27536.001B.4.
|